Can someone have Medicare and Medicaid at the same time?

amother

Cobalt

Mon, Mar 23 2015, 12:20 pm

My mom is a senior citizen in her mid eighties, kein yirbu. She has been on Medicare for many years. In recent times she needs more and more help around the house, such as home health care and a visiting nurse or doctor, maybe even a companion to spend time with her each day and take care of her daily needs such as bathing and housekeeping. Someone suggested that she should apply for Medicaid because they might pay for some of these services. Does anyone know if my mom can keep her Medicare coverage and have Medicaid at the same time? Thanks for any info you can provide.

abby1776

Mon, Mar 23 2015, 12:56 pm

I googled your question and this is the first thing that came up:

Can a senior get both Medicaid and Medicare?
Q: Can a senior qualify for Medicaid if they already receive Medicare?
A: Yes, a person can receive both Medicare and Medicaid. When a Medicare beneficiary begins receiving Medicaid benefits they are deemed a "Dual Eligible." Dual eligibles have enhanced benefits.
Here's how it works: Medicare continues to be the person's primary insurer. They are free to go to any provider that accepts Medicare. This means they are not limited to "Medicaid Doctors" (as those who are not Medicare eligible typically are).
If the beneficiary has a Medicare supplement or is a member of an HMO or other Medicare Part C Advantage plan, that insurer will be the secondary insurer. In this case, Medicaid is now the "tertiary" insurer and picks up expenses that Medicare and the HMO do not.
Dual eligibles also have their Part B Medicare premium paid and their Part D prescription premium subsidized. Co-pays for prescriptions medicine go to $1 and $5 with no "donut hole." Medicaid may also provide long-term care services in addition to the above depending on the recipient's circumstances.
Unless Social Security determines that you are disabled, you are eligible for Medicare when you turn 65. Much of the premium has been paid if you have worked the requisite number of quarters and contributed to Social Security. As a Medicare beneficiary (or even if you are not) you may be eligible for Medicaid if you have limited income and resources.

Amarante

Mon, Mar 23 2015, 1:02 pm

I'm not an expert but some of the services you are asking about are covered by Medicare and her Medigap policy. If a doctor says it is "medically" necessary, a visiting nurse will come - also occupational therapy and physical therapy will come to the home.

Medicare will also cover the costs for someone who needs help bathing but that would need to be a medical requirement - again prescribed by the doctor. Most doctors would be helpful if the person has issues with balance/falling etc.

Medicare doesn't cover the costs for a companion/cleaner so the home health aide can't perform those services but only medical services or help with stuff like bathing. I don't know what the frequency would be but you can check with Medicare. ETA - Perhaps there are social services in her area that can help with delivery of meals. Again, sometimes there are senior "day care" centers and they will pick up and take home seniors who are otherwise stuck at home with no one. Sounds awful but socialization with other people is very helpful. I meant calling it "day care" sounds infantilizing but a lot of seniors benefit from having a good social environment to look forward to and it's not day care like for children but just a place to get together.

I don't know much about Medicaid except that it pays for long term nursing care after Medicare coverage runs out and also the person needs to have very low assets. But it doesn't seem as though your mother needs to be in a nursing home but just has reached a stage in life when she needs help with acts of "normal living".

LiLIsraeli

Mon, Mar 23 2015, 1:10 pm

Yes, absolutely. Medicare would be the primary insurance and Medicaid the secondary. Medicaid is income-based so if she is low-income, she may very well qualify. A person who has Medicare and also is eligible for Medicaid is called QMB - qualified Medicare beneficiary.

See this link for more information: http://www.medicaid.gov/medica......html

If she is below the income limit, you can go with her to your local social services agency and apply.

kollel wife

Mon, Mar 23 2015, 1:57 pm

I have done this for my mother-in-law - also in her eighties.
She now has both Medicaid and Medicare. Medicare will only pay for short term rehab,physical therapy or help. There is also an agency in Lakewood call Medicaid Solutions that can help you apply.
PM me if you live in New Jersey - although I don't check those messages daily, but I did the whole application myself.
You will need 5 years of bank statements and assets under 2,000. Unexplained expenses or giving away money will be penalized.